Provider Demographics
NPI:1750451357
Name:FOUR LEAF CLOVER, INC
Entity Type:Organization
Organization Name:FOUR LEAF CLOVER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-777-3203
Mailing Address - Street 1:3280 HWY 69
Mailing Address - Street 2:SUITE II
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-1007
Mailing Address - Country:US
Mailing Address - Phone:888-777-3203
Mailing Address - Fax:828-389-9779
Practice Address - Street 1:3280 HWY 69
Practice Address - Street 2:SUITE II
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-1007
Practice Address - Country:US
Practice Address - Phone:888-777-3203
Practice Address - Fax:828-389-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2004-16341332B00000X
NC332B00000X
NC1035023332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000965346AMedicaid
KS100454120 AMedicaid
OK200003930 AMedicaid
AZ464074Medicaid
PA001963766Medicaid
TN4582201Medicaid
MI4503699Medicaid
TX145573501Medicaid
AR146926741Medicaid
KY9000515800Medicaid
MS00440785Medicaid
NC600678485OtherNC STATE ID
IL65-509-5427-001Medicaid
CT003107887Medicaid
OR182741Medicaid
IN200408900 AMedicaid
OH2254804Medicaid
NC7703099Medicaid
MD7777027 00Medicaid
R8517OtherBLUE CROSS BLUE SHIELD
IL65-509-5427-001Medicaid
MD7777027 00Medicaid
MS00440785Medicaid